Gert van der Hoek
In Memoriam - Editor, Senior Moderator
November 2015
Why focus on carbapenemase-producing Enterobacteriaceae?
The global rise of carbapenemase-producing Enterobacteriaceae (CPE) is alarming and represents an increasing threat to healthcare delivery and patient safety. It also results in higher healthcare costs, prolonged hospital stays, treatment failures and sometimes death. Carbapenems are a major last-line class of antibiotics to treat infections with multidrug-resistant gram-negative bacteria, including Enterobacteriaceae such as Klebsiella pneumoniae. But CPE are resistant to carbapenems due to the production of an enzyme ? a carbapenemase. There are only few remaining treatment options for patients infected with CPE. These are limited to combination therapy and to older antibiotics such as polymyxins (e.g. colistin). Countries with already high percentages of carbapenem resistance due to the spread of CPE also report increasing numbers of isolates with polymyxin resistance [4], indicating a further loss of effective antibiotic treatment for these infections. Specific infection control measures, combined with prudent use of antibiotics, are key to controlling the spread of CPE in European hospitals. Failing this, Europe may rapidly face hospital outbreaks of extensively drug-resistant (XDR), or even pandrug-resistant (PDR), Enterobacteriaceae.
What is the situation in Europe?
In 2015, four countries reported an endemic situation for CPE, and nine countries reported interregional spread of CPE. The occurrence and spread of CPE in Europe has continued to worsen over the last two years. Thirteen (34%) countries reported interregional spreadi of or an endemic situationii for CPE in 2015, compared to six (15%) countries in 2013.
In 2013, only two countries reported sporadic hospital outbreaks of NDM CPEiii . In 2015, five countries reported sporadic hospital outbreaks of NDM CPE, and seven countries reported regional and interregional spread of NDM CPE. NDM CPE is rapidly spreading in European hospitals. Since the first case was published in 2009, the number of NDM CPE cases reported by most European countries has remained relatively low compared with other CPEs. In 2013, only Italy and the United Kingdom reported sporadic hospital outbreaksiv . The situation dramatically changed in 2015, with five countries reporting sporadic hospital outbreaks and seven countries reporting regional v and interregional spread.
In 2013, only one country reported an endemic situation, and no country reported interregional spread of OXA-48 CPEvi . In 2015, two countries reported an endemic situation, and four countries reported interregional spread of OXA-48 CPE. OXA-48 CPE also continue to spread rapidly in European hospitals. Since the first reported case in Turkey in 2003, OXA-48 CPE have spread worldwide and are now commonly found in Europe. In 2013, only one European country had reported an endemic situation of OXA-48 CPE, while in 2015, two countries reported an endemic situation and four countries reported interregional spread.
What are the main challenges? Four countries do not have a national reference/expert laboratory for CPE. Seven countries do not have a national surveillance system dedicated to CPE. Ten countries replied that there is no system for notification of CPE cases to health authorities. Fourteen countries do not have national guidelines for prevention and control of CPE. Twenty-seven countries do not have a national plan for containment of CPE.
What can be done?
Options for policymakers to support the prevention and control of the spread of carbapenemase-producing Enterobacteriaceae, based on the EuSCAPE Project
Establish a national plan for containment of (or preparedness to contain) CPE.
Establish a dedicated surveillance system for CPE.
Support the establishment of a reference laboratory for antimicrobial resistance, including CPE.
Implement mandatory reporting of CPE by clinical microbiology laboratories to the reference laboratory.
Implement notification of CPE cases to health authorities.
Implement national guidelines for prevention and control of CPE.
Why focus on carbapenemase-producing Enterobacteriaceae?
The global rise of carbapenemase-producing Enterobacteriaceae (CPE) is alarming and represents an increasing threat to healthcare delivery and patient safety. It also results in higher healthcare costs, prolonged hospital stays, treatment failures and sometimes death. Carbapenems are a major last-line class of antibiotics to treat infections with multidrug-resistant gram-negative bacteria, including Enterobacteriaceae such as Klebsiella pneumoniae. But CPE are resistant to carbapenems due to the production of an enzyme ? a carbapenemase. There are only few remaining treatment options for patients infected with CPE. These are limited to combination therapy and to older antibiotics such as polymyxins (e.g. colistin). Countries with already high percentages of carbapenem resistance due to the spread of CPE also report increasing numbers of isolates with polymyxin resistance [4], indicating a further loss of effective antibiotic treatment for these infections. Specific infection control measures, combined with prudent use of antibiotics, are key to controlling the spread of CPE in European hospitals. Failing this, Europe may rapidly face hospital outbreaks of extensively drug-resistant (XDR), or even pandrug-resistant (PDR), Enterobacteriaceae.
What is the situation in Europe?
In 2015, four countries reported an endemic situation for CPE, and nine countries reported interregional spread of CPE. The occurrence and spread of CPE in Europe has continued to worsen over the last two years. Thirteen (34%) countries reported interregional spreadi of or an endemic situationii for CPE in 2015, compared to six (15%) countries in 2013.
In 2013, only two countries reported sporadic hospital outbreaks of NDM CPEiii . In 2015, five countries reported sporadic hospital outbreaks of NDM CPE, and seven countries reported regional and interregional spread of NDM CPE. NDM CPE is rapidly spreading in European hospitals. Since the first case was published in 2009, the number of NDM CPE cases reported by most European countries has remained relatively low compared with other CPEs. In 2013, only Italy and the United Kingdom reported sporadic hospital outbreaksiv . The situation dramatically changed in 2015, with five countries reporting sporadic hospital outbreaks and seven countries reporting regional v and interregional spread.
In 2013, only one country reported an endemic situation, and no country reported interregional spread of OXA-48 CPEvi . In 2015, two countries reported an endemic situation, and four countries reported interregional spread of OXA-48 CPE. OXA-48 CPE also continue to spread rapidly in European hospitals. Since the first reported case in Turkey in 2003, OXA-48 CPE have spread worldwide and are now commonly found in Europe. In 2013, only one European country had reported an endemic situation of OXA-48 CPE, while in 2015, two countries reported an endemic situation and four countries reported interregional spread.
What are the main challenges? Four countries do not have a national reference/expert laboratory for CPE. Seven countries do not have a national surveillance system dedicated to CPE. Ten countries replied that there is no system for notification of CPE cases to health authorities. Fourteen countries do not have national guidelines for prevention and control of CPE. Twenty-seven countries do not have a national plan for containment of CPE.
What can be done?
Options for policymakers to support the prevention and control of the spread of carbapenemase-producing Enterobacteriaceae, based on the EuSCAPE Project
Establish a national plan for containment of (or preparedness to contain) CPE.
Establish a dedicated surveillance system for CPE.
Support the establishment of a reference laboratory for antimicrobial resistance, including CPE.
Implement mandatory reporting of CPE by clinical microbiology laboratories to the reference laboratory.
Implement notification of CPE cases to health authorities.
Implement national guidelines for prevention and control of CPE.